[2] ADHD is primarily characterized by "the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone."[3]

.ADHD is the most commonly studied and diagnosed for children psychiatric disorder in children, affecting about 3 to 5% of children globally with symptoms starting before seven years of age.^The children included in this study had diagnoses of ADHD with depressive symptoms, ADHD and major depressive disorder, or major depressive disorder with prominent attentional symptoms.

[4][5].ADHD is a common chronic disorder in children[6] with 30 to 50% of those individuals diagnosed in childhood continuing to have symptoms into adulthood.^Half the children with ADHD continue to have symptoms through adulthood.

^Atomoxetine shows no abuse potential and is not a controlled substance in the US. In November of 2002 the FDA approved atomoxetine for use in the US for the treatment of ADHD in children, adolescents and adults.

^Subjects were adults who met criteria for ADHD, met Utah criteria for ADHD in adulthood, had a definite childhood history of ADHD, had no psychiatric disorder, and were unmedicated prior to the study.

[10].4.7 percent of American adults are estimated to live with ADHD.[11] ADHD is diagnosed two to four times as frequently in boys as in girls,[12][13] though studies suggest this discrepancy may be due to subjective bias of referring teachers.^Two to three times more boys than girls are affected.

[14].ADHD management usually involves some combination of medications, behavior modifications, lifestyle changes, and counseling.^Methods of treatment usually involve some combination of medications, behaviour modifications, life style changes, and counseling.

.Its symptoms can be difficult to differentiate from other disorders, increasing the likelihood that the diagnosis of ADHD will be missed[15] or vice versa.^Differential diagnosis and treatment of adult ADHD and neighboring disorders.

^Certain social critics are highly skeptical that the diagnosis denotes a genuine impairment and question virtually all that is known about ADHD. The symptoms of ADHD are not as profoundly different from normal behavior as are those of other chronic mental disorders .

.Additionally, most clinicians have not received formal training in the assessment and treatment of ADHD, particularly in adult patients.^There are many alternative treatments for ADHD, most of them heavily disputed or relegated to adjunct status with medication treatment.

^In this paper we present a structured skill training program particularly tailored for adult patients with ADHD. The program is based on the principles of cognitive-behavioral treatment for borderline personality disorder developed by M. Linehan.

^Additionally, the FDA recommended "that children, adolescents, or adults who are being considered for treatment with ADHD drug products work with their physician or other health care professional to develop a treatment plan that includes a careful health history and evaluation of current status, particularly for cardiovascular and psychiatric problems (including assessment for a family history of such problems)."

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

[16].The controversies have involved clinicians, teachers, policymakers, parents and the media.^ADHD has been surrounded by great controversy involving clinicians, teachers, policymakers, parents, and the media.

.Opinions regarding ADHD range from not believing it exists at all to believing there are genetic and physiological bases for the condition as well as disagreement about the use of stimulant medications in treatment.^The range of opinion regarding the validity of ADHD extends from those who do not believe it exists and regard it as a myth, to those who believe that there is genetic and physiological evidence supporting its existence.

[20][21][22] The AMA Council on Scientific Affairs concluded in 1998 that "diagnostic criteria for ADHD are based on extensive empirical research and, if applied appropriately, lead to the diagnosis of a syndrome with high interrater reliability, good face validity, and high predictability of course and medication responsiveness."[23]

Classification

.ADHD may be seen as one or more continuous traits found normally throughout the general population.^Children who have ADHD usually have at least one close relative who also has ADHD. And at least one-third of all fathers who had ADHD in their youth bear children who have ADHD. Even more convincing: the majority of identical twins share the trait.

^Speculation exists to explain the higher diagnostic quota in the U.S. One theory suggests that due to the high-risk traits of ADHD-affected people, it can be suggested that there was a higher prevalence for ADHD in the immigrants heading for America in former centuries than in the general population.

[24].ADHD is a developmental disorder in which certain traits such as impulse control lag in development.^The term "developmental" means that certain traits such as impulse control significantly lag in development when compared to the general population.

^Objective: This pilot study examined the effects of atomoxetine on attention-deficit/hyperactivity disorder (ADHD) symptoms and autistic features in children with pervasive developmental disorders (PDD).

[25].Using magnetic resonance imaging of the prefrontal cortex, this developmental lag has been estimated to range from 3 to 5 years.^Brain scans using imaging techniques, including magnetic resonance imaging (MRI) or single photon emission computed tomography (SPECT) may eventually help confirm a diagnosis.

[26].These delays are considered to cause impairment.^This developmental lag has been estimated to range between 30-40 percent in ADHD sufferers in comparison to their peers; consequently these delayed attributes are considered an impairment.

[27].A diagnosis of ADHD does not, however, imply a neurological disease.^However, there is no scientific evidence to support this treatment at this time nor does it appear to be consistent with current evidence on the causes of ADHD. .

^Remember, taking a drug such as Ritalin does not automatically imply that the child has AD/HD, nor does having a diagnosis of AD/HD imply that the student will automatically qualify for special education services.

The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.

Children with this subtype are less likely to act out or have difficulties getting along with other children.

^ADHD children with the inattentive subtype are more likely to be picked on and to spend time alone.

.They may sit quietly, but they are not paying attention to what they are doing.^For many people, this is what it's like to have Attention Deficit Hyperactivity Disorder, or ADHD. They may be unable to sit still, plan ahead, finish tasks, or be fully aware of what's going on around them.

.It is a health condition involving biologically active substances in the brain.^Among the various vitamin E components (tocopherols and tocotrienols), only alpha-tocopherol is actively uptaken by the brain and is directly involved in nervous membranes protection.

.January 2010" style="white-space:nowrap;">[citation needed] In childhood ADHD, and some cases of adult ADHD, biological active chemicals in the brain are in the state of equilibrium and disequilibrium.^Therefore, research has been directed towards determining if the treatment of ADHD with stimulant medications can be safe and effective for the individual with active SUD and concomitant ADHD. An initial trial of methylphenidate in a population of adults with active cocaine dependence and ADHD indicates that this is the case.

.January 2010" style="white-space:nowrap;">[citation needed] ADHD may affect certain areas of the brain that allow problem solving, planning ahead, understanding others’ actions, and impulse control.^Understanding the Problem What are the symptoms of ADHD? Can any other conditions produce these symptoms?

^For many people, this is what it's like to have Attention Deficit Hyperactivity Disorder, or ADHD. They may be unable to sit still, plan ahead, finish tasks, or be fully aware of what's going on around them.

^The child's social skills are resources for solving the specific problems that arise from ADHD. Interpersonal problems and difficulties with peers may occur secondary to impulsivity (i.e., unpredictable behavior).

.If a child seems too active on the playground but not elsewhere, the problem might not be ADHD. It might also not be ADHD if the behaviors occur in the classroom but nowhere else.^Treatment for ADHD is based on your or your child's symptoms and problem behaviors.

.Even if a child’s behavior seems like ADHD, it might not actually be ADHD; careful attention to the process of differential diagnosis is mandatory.^Which ADHD -like behaviors listed in the DSM does the child show?

[32] Many adults, however, remain untreated.[31].Untreated adults with ADHD often have chaotic lifestyles, may appear to be disorganized and may rely on non-prescribed drugs and alcohol to get by.^ADHD may also be underdiagnosed in adults.

[33].A diagnosis of ADHD may offer adults insight into their behaviors and allow patients to become more aware and seek help with coping and treatment strategies.^ADHD in adolescents: Diagnosis and treatment .

[32].There is controversy amongst some experts on whether ADHD persists into adulthood.^In many cases, symptoms persist into adolescence and adulthood, causing significant lifelong impairments in academic, career, and social functioning.

.Recognized as occurring in adults in 1978, it is currently not addressed separately from ADHD in childhood.^Next, Frederick W. Reimherr, MD, reviews comorbidity of ADHD and describes the Utah Criteria as a method of diagnosing adults through recollection of childhood problems.

^Subjects were adults who met criteria for ADHD, met Utah criteria for ADHD in adulthood, had a definite childhood history of ADHD, had no psychiatric disorder, and were unmedicated prior to the study.

^Adult ADHD often presents differently from childhood ADHD. Because adult ADHD can be comorbid with other disorders and has symptoms similar to those of other disorders, it is important to understand differential diagnoses.

Obstacles that clinicians face when assessing adults who may have ADHD include developmentally inappropriate diagnostic criteria, age-related changes, comorbidities and the possibility that high intelligence or situational factors can mask ADHD.

Symptoms

.Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. The symptoms of ADHD are especially difficult to define because it is hard to draw the line at where normal levels of inattention, hyperactivity, and impulsivity end and clinically significant levels requiring intervention begin.^Research indicates that girls with ADHD are often inattentive but not hyperactive or impulsive.

[15].To be diagnosed with ADHD, symptoms must be observed in two different settings for six months or more and to a degree that is greater than other children of the same age.^That is, do they occur more often than in other people the same age?

The symptom categories of ADHD in children yield three potential classifications of ADHD—predominantly inattentive type, predominantly hyperactive-impulsive type, or combined type if criteria for both subtypes are met:[15]:p.4

Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences

Have difficulty waiting for things they want or waiting their turns in games

.Most people exhibit some of these behaviors, but not to the degree where such behaviors significantly interfere with a person's work, relationships, or studies.^PubMed ] Cadoret RJ, Stewart MA. An adoption study of attention deficity/hyperactivity/aggression and their relationship to adult antisocial personality.

The core impairments are consistent even in different cultural contexts.[36]

.Symptoms may persist into adulthood for up to half of children diagnosed with ADHD. Estimating this is difficult as there are no official diagnostic criteria for ADHD in adults.^Half the children with ADHD continue to have symptoms through adulthood.

.The signs and symptoms may differ from those during childhood and adolescence due to the adaptive processes and avoidance mechanisms learned during the process of socialisation.^Other research is seeking to identify conditions of pregnancy and early childhood that may cause or contribute to these differences in the brain.

^Researchers are also searching for other differences between those who have and do not have ADHD. Research on how the brain normally develops in the fetus offers some clues about what may disrupt the process.

.Academic studies and research in private practice suggest that depression in ADHD appears to be increasingly prevalent in children as they get older, with a higher rate of increase in girls than in boys, and to vary in prevalence with the subtype of ADHD. Where a mood disorder complicates ADHD it would be prudent to treat the mood disorder first, but parents of children who have ADHD often wish to have the ADHD treated first, because the response to treatment is quicker.^Research indicates that girls with ADHD are often inattentive but not hyperactive or impulsive.

^Within each specialty, individual doctors and mental health professionals differ in their experience with ADHD. So in selecting a specialist, it's important to find someone with specific training and experience in diagnosing and treating the disorder.

.These children tend to fidget, yawn and stretch and appear to be hyperactive in order to remain alert and active.^People with vigilance disorder tend to fidget, yawn and stretch, and appear to be hyperactive in order to remain alert; they typically have kind and affectionate temperaments.

^This preliminary study compared the daily living skills of children with and without attention-deficit-hyperactivity disorder (ADHD), and the influence of a social skills training group on these skills.

Mood disorders. .Boys diagnosed with the combined subtype have been shown likely to suffer from a mood disorder.^The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) distinguishes among a primarily inattentive subtype, a hyperactive-impulsive subtype, and a combined subtype ( American Psychiatric Association, 1994 ).

Bipolar disorder. .As many as 25% of children with ADHD have bipolar disorder.^OBJECTIVE: To test the hypothesis that transdermal nicotine would be efficacious for the treatment of children and adolescents with attention deficit hyperactivity disorder (ADHD).

^The results showed that only those children in the two medication treatment conditions demonstrated improvement in both attentional and behavioral ratings and that the combination therapy was not any more effective than MPH alone.

^The challenges that all children face, like changing schools or entering puberty, may be even more stressful for a child with ADHD. Some doctors recommend that children be taken off a medication now and then to see if the child still needs it.

.OCD is believed to share a genetic component with ADHD and shares many of its characteristics.^Many experts now believe that an essential feature in ADHD, as well as in learning disabilities, is an impaired working (also called short-term) memory.

[24].Hyperactivity also seems to be primarily a genetic condition; however, other causes do have an effect.^Other research is seeking to identify conditions of pregnancy and early childhood that may cause or contribute to these differences in the brain.

.Researchers believe that a large majority of ADHD cases arise from a combination of various genes, many of which affect dopamine transporters.^Many experts now believe that an essential feature in ADHD, as well as in learning disabilities, is an impaired working (also called short-term) memory.

.The broad selection of targets indicates that ADHD does not follow the traditional model of "a genetic disease" and should therefore be viewed as a complex interaction among genetic and environmental factors.^More efforts should be made to understand the implications that different diagnostic models for ADHD and comorbid disorders could have on the outcomes of treatment.

Evolutionary theories

The hunter vs. farmer theory is a hypothesis proposed by author Thom Hartmann about the origins of ADHD. The theory proposes that hyperactivity may be an adaptive behavior in pre modern humans[52] and that those with ADHD retain some of the older "hunter" characteristics associated with early pre-agricultural human society. .According to this theory, individuals with ADHD may be more adept at searching and seeking and less adept at staying put and managing complex tasks over time.^The technique works well with all children, although children with ADHD may need more frequent rewards.

[53].Further evidence showing hyperactivity may be evolutionarily beneficial was put forth in 2006 in a study which found it may carry specific benefits for a society.^Nicotinic medications may provide beneficial therapeutic treatment for cognitive dysfunction such as Alzheimer's disease, schizophrenia and attention deficit hyperactivity disorder (ADHD).

Environmental factors

.Twin studies to date have also suggested that approximately 9% to 20% of the variance in hyperactive-impulsive-inattentive behavior or ADHD symptoms can be attributed to nonshared environmental (nongenetic) factors.^Research indicates that girls with ADHD are often inattentive but not hyperactive or impulsive.

^The word often appears before each symptom of inattention, hyperactivity, and impulsivity in the DSM-IV-TR. In order to be considered a symptom of AD/HD, a behavior can't be "a once in a while" problem.

.Environmental factors implicated include alcohol and tobacco smoke exposure during pregnancy and environmental exposure to lead in very early life.^Environmental factors that have been most consistently associated with ADHD include maternal smoking during pregnancy, 21,22 emotional distress or family adversity during pregnancy and early in life, 21,23,24 birth weight <1500 g, 24 hypoxemia, 25 encephalitis, 26 trauma, 27 lead exposure, 28 and brain injury from some metabolic disorders.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^A group of symptoms attributed to prenatal exposure to alcohol which include patterns of delayed growth, developmental delay or intellectual disability, learning disabilities, and/or attention disorders.

[59].The relation of smoking to ADHD could be due to nicotine causing hypoxia (lack of oxygen) to the fetusin utero.^Although such findings should certainly not encourage anyone to smoke, some studies are focusing on benefits of nicotine therapy in adults with ADHD. .

[60].It could also be that women with ADHD are more likely to smoke[61] and therefore, due to the strong genetic component of ADHD, are more likely to have children with ADHD.[62] Complications during pregnancy and birth—including premature birth—might also play a role.^The children included in this study had diagnoses of ADHD with depressive symptoms, ADHD and major depressive disorder, or major depressive disorder with prominent attentional symptoms.

[63].ADHD patients have been observed to have higher than average rates of head injuries;[64] however, current evidence does not indicate that head injuries are the cause of ADHD in the patients observed.^Scientists, however, do need to study causes in an effort to identify better ways to treat, and perhaps some day, prevent ADHD .

[65].Infections during pregnancy, at birth, and in early childhood are linked to an increased risk of developing ADHD. These include various viruses (measles, varicella, rubella, enterovirus 71) and streptococcal bacterial infection.^Environmental factors that have been most consistently associated with ADHD include maternal smoking during pregnancy, 21,22 emotional distress or family adversity during pregnancy and early in life, 21,23,24 birth weight <1500 g, 24 hypoxemia, 25 encephalitis, 26 trauma, 27 lead exposure, 28 and brain injury from some metabolic disorders.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^Other research is seeking to identify conditions of pregnancy and early childhood that may cause or contribute to these differences in the brain.

Diet

.A study[68] conducted by researchers at Southampton University in the United Kingdom and published in The Lancet on November 3, 2007 found a definitive link between children’s ingestion of many commonly used artificial food colors, the preservative sodium benzoate and hyperactivity.^PubMed ] Rose TL. The functional relationship between artificial food colors and hyperactivity.

^New guidelines to assess cardiac risk before using stimulant medication in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) were published concurrently in 3 Canadian medical society journals in November.

In response to these findings, the British government took prompt action. .According to the Food Standards Agency, the food regulatory agency in the UK, food manufacturers are being encouraged to voluntarily phase out the use of most artificial food colors by the end of 2009. Following the FSA’s actions, the European Commission ruled that any food products containing the “Southampton Six” (The contentious colourings are: sunset yellow FCF (E110), quinoline yellow (E104), carmoisine (E122), allura red (E129), tartrazine (E102) and ponceau 4R (E124)) must display warning labels on their packaging by 2010. In the US, little has been done to curb food manufacturer’s use of specific food colors, despite the new evidence presented by the Southampton study.^Any artificial colorings (particularly yellow, red, or green) Other chemical additives -- for example, BHT or BHA Milk Chocolate Eggs Wheat Foods containing salicylates, including all berries, chili powder, apples and cider, cloves, grapes, oranges, peaches, peppers (bell & chili), plums, prunes, tomatoes.

.However, the existing US Food Drug and Cosmetic Act[69] had already required that artificial food colors be approved for use, that they must be given FD&C numbers by the FDA, and the use of these colors must be indicated on the package.^These drugs have a number of side effects.

^Atomoxetine shows no abuse potential and is not a controlled substance in the US. In November of 2002 the FDA approved atomoxetine for use in the US for the treatment of ADHD in children, adolescents and adults.

[70] This is why food packaging in the USA may state something like: "Contains FD&C Red #40."

Social factors

.The World Health Organization states that the diagnosis of ADHD can represent family dysfunction or inadequacies in the educational system rather than individual psychopathology.^Thus, in 1998, the National Institutes of Health consensus panel on the diagnosis and treatment of ADHD concluded that the costs associated with ADHD were large, stating that individuals with ADHD "consume a disproportionate share of resources and attention from the health care system, criminal justice system, schools, and other social service agencies."

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^Although these are often described as "symptoms" they are really "signs" of ADHD, as they are observed phenomena rather than subjective experiences of the patients.

[71].Russell Barkley however disagrees and finds no compelling evidence that social factors alone can cause ADHD.[25] Other researchers believe that relationships with caregivers have a profound effect on attentional and self-regulatory abilities.^Scientists, however, do need to study causes in an effort to identify better ways to treat, and perhaps some day, prevent ADHD .

.A study of foster children found that a high number of them had symptoms closely resembling ADHD.[72] Researchers have found behavior typical of ADHD in children who have suffered violence and emotional abuse.^Children who have ADHD usually have at least one close relative who also has ADHD .

^Atomoxetine shows no abuse potential and is not a controlled substance in the US. In November of 2002 the FDA approved atomoxetine for use in the US for the treatment of ADHD in children, adolescents and adults.

Neurodiversity

.Proponents of the neurodiversity theory assert that atypical (neurodivergent) neurological development is a normal human difference that is to be tolerated and respected just like any other human difference.^Other tests are available to test neurologic, intellectual, and emotional development problems.

.Social critics argue that while biological factors may play a large role in difficulties with sitting still in class and/or concentrating on schoolwork in some children, these children could have failed to integrate others' social expectations of their behavior for a variety of other reasons.^Children may be referred for an ADHD evaluation by a variety of individuals for a variety of reasons.

^Review of the available data suggests that some of the children who died may have had the specific types of cardiac lesions that predispose to SCD. Others who died were not known to have any of these risk factors, but few data are available because these data were provided voluntarily through the FDA Adverse Event Reporting System by a variety of reporters, including parents, doctors, coroners, pharmacists, other health professionals, and media reporters, resulting in possible underreporting or limited reports.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^This preliminary study compared the daily living skills of children with and without attention-deficit-hyperactivity disorder (ADHD), and the influence of a social skills training group on these skills.

[76] It has been said that ADHD has a link with creativity.[77].As genetic research into ADHD proceeds, it may become possible to integrate this information with the neurobiology in order to distinguish disability from varieties of normal or even exceptional functioning in people along the same spectrum of attention differences.^Various diagnostic models may well define samples that differ in natural history, severity, comorbidity, ADHD subtype, and response to treatment.

^Infant malnutrition is a strong risk factor of ADHD. Even if children receive enough food later on, infants who suffer from malnutrition may develop behavior problems, the most prevalent being attention-deficit disorder.

Social construct theory of ADHD

.Social construction theory states that it is societies that determine where the line between normal and abnormal behavior is drawn.^Barkley RA. Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin.

.Thus society members including physicians, parents, teachers, and others are the ones who determine which diagnostic criteria are applied and thus determine the number of people affected.^The behavior ratings included Diagnostic and Statistical Manual of Mental Disorders criteria, number of problems, and social behavior at school and were conducted by parents and teachers.

^This may include other teachers, including those who have previously worked with the student, the Consulting Teacher (or special education supervisor if needed), and/or the Resource Teacher, the School Counselor, and/or the Principal or other administrator.

[79] This is exemplified in the fact that the DSM IV arrives at levels of ADHD three to four times higher than those obtained with use of the ICD 10.[13]Thomas Szasz, an extreme proponent of this theory, has gone so far as to state that ADHD was "invented and not discovered."[80][81]

Low arousal theory

.According to the low arousal theory, people with ADHD need excessive activity as self-stimulation because of their state of abnormally low arousal.^Fact : Stimulants allow many people to focus and pay better attention, whether or not they have ADHD .

[82][83].The theory states that those with ADHD cannot self-moderate, and their attention can only be gained by means of environmental stimuli,[82] which in turn results in disruption of attentional capacity and an increase in hyperactive behaviour.^Attention deficit hyperactivity disorder (ADHD) .

.Without enough stimulation coming from the environment, an ADHD child will create it him or herself by walking around, fidgeting, talking, etc.^It is a condition that is significantly related to each child's environment (home, school, etc.

.This theory also explains why stimulant medications have high success rates and can induce a calming effect at therapeutic dosages among children with ADHD. It establishes a strong link with scientific data that ADHD is connected to abnormalities with the neurochemical dopamine and a powerful link with low-stimulation PET scan results in ADHD subjects.^The results indicate that stimulant medication improved recognition memory for children with ADHD. .

^New guidelines to assess cardiac risk before using stimulant medication in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) were published concurrently in 3 Canadian medical society journals in November.

Pathophysiology

Diagram of a human brain.

.The pathophysiology of ADHD is unclear and there are a number of competing theories.^There is a genetic basis in about 80% of the cases, involving a number of different genes, and in about 20% of the cases, ADHD is the result of an acquired insult to the brain.

[85].Research on children with ADHD has shown a general reduction of brain volume, but with a proportionally greater reduction in the volume of the left-sided prefrontal cortex.^ADHD in Children With Heart Disease ADHD may be more prevalent in children with heart disease than in the general pediatric population.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^Aman MG, Kern RA, McGhee DE, Arnold LE. Fenfluramine and methylphenidate in children with mental retardation and ADHD: Clinical and side effects.

.These findings suggest that the core ADHD features of inattention, hyperactivity, and impulsivity may reflect frontal lobe dysfunction, but other brain regions particularly the cerebellum have also been implicated.^Hyperactive-impulsive ADHD subjects may be more disruptive and aggressive.

[86].Neuroimaging studies in ADHD have not always given consistent results and as of 2008 are only used for research not diagnostic purposes.^No studies were designed to determine the proportion of adults with ADHD who will use, and benefit from, other interventions, particularly nonpharmacological.

[87].A 2005 review of published studies involving neuroimaging, neuropsychological genetics, and neurochemistry found converging lines of evidence to suggest that four connected frontostriatal regions play a role in the pathophysiology of ADHD: The lateral prefrontal cortex, dorsal anterior cingulate cortex, caudate, and putamen.^Evidence from neuroimaging studies.

^Central Nervous System Involvement Converging evidence from neuropsychology, neuroimaging, neuropharmacology, and genetics suggests involvement of the frontostriatal dopaminergic circuits in the brain.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^Converging evidence from animal and human studies implicates the dysregulation of frontal-subcortical-cerebellar catecholaminergic circuits in the pathophysiology of ADHD, and molecular imaging studies suggest that abnormalities of the dopamine transporter lead to impaired neurotransmission.

.In one study a delay in development of certain brain structures by an average of three years occurred in ADHD elementary school aged patients.^Studies evaluating therapies for ADHD in adults (> 18 years of age).

The delay was most prominent in the frontal cortex and temporal lobe, which are believed to be responsible for the ability to control and focus thinking. .In contrast, the motor cortex in the ADHD patients was seen to mature faster than normal, suggesting that both slower development of behavioral control and advanced motor development might be required for the fidgetiness that characterizes ADHD.[89] It should be noted that stimulant medication itself may affect growth factors of the central nervous system.^A: ADHD patients may develope depression and Strattera may also cause it.

^Faster processing and improved executive function performance may covary because they both reflect more efficient neural processing and improved signal/noise ratios, either because of systemwide improvements in the nervous system or because a better functioning prefrontal cortex improves signal/noise ratios for diverse neural regions, permitting faster and more efficient cognitive processing.

.The same laboratory had previously found involvement of the "7-repeat" variant of the dopamine D4 receptor gene, which accounts for about 30 percent of the genetic risk for ADHD, in unusual thinness of the cortex of the right side of the brain; however, in contrast to other variants of the gene found in ADHD patients, the region normalized in thickness during the teen years in these children, coinciding with clinical improvement.^The prevalence of these conditions in children with ADHD ranges from 15 to 30 percent.

.Additionally, SPECT scans found people with ADHD to have reduced blood circulation (indicating low neural activity),[92] and a significantly higher concentration of dopamine transporters in the striatum which is in charge of planning ahead.^CONCLUSION: In adolescents, once-daily OROS methylphenidate significantly reduced ADHD symptoms and was well tolerated using dosages up to 72 mg/d.

[93][94].A study by the U.S. Department of Energy’s Brookhaven National Laboratory in collaboration with Mount Sinai School of Medicine in New York suggest that it is not the dopamine transporter levels that indicate ADHD, but the brain's ability to produce dopamine itself.^In people with ADHD , the brain areas that control attention used less glucose, indicating that they were less active.

.The study found that it was not the transporter levels that indicated ADHD, but the dopamine itself.^Double-blind, placebo-, and active comparator-controlled studies are indicated to rigorously test the efficacy of reboxetine in ADHD. ----- J Am Acad Child Adolesc Psychiatry.

ADHD subjects showed lower levels of dopamine across the board. .They speculated that since ADHD subjects had lower levels of dopamine to begin with, the number of transporters in the brain was not the telling factor.^Although these are often described as "symptoms" they are really "signs" of ADHD, as they are observed phenomena rather than subjective experiences of the patients.

.In support of this notion, plasma homovanillic acid, an index of dopamine levels, was found to be inversely related not only to childhood ADHD symptoms in adult psychiatric patients, but to "childhood learning problems" in healthy subjects as well.^The children had been referred to a psychiatric clinic for disruptive behavior problems and met criteria for ADHD based on parent and teacher interviews.

[95].One interpretation of dopamine pathway tracers is that the biochemical "reward" mechanism works for those with ADHD only when the task performed is inherently motivating; low levels of dopamine raise the threshold at which someone can maintain focus on a task which is otherwise boring.^Individuals with ADD have difficulty maintaining a sufficiently high level of motivation to complete a task and grow bored quickly, perhaps tiring because the working memory demands of the task exhaust them.

[97].Further studies found that chronic stimulant treatment had little effect on global glucose metabolism,[98] a 1993 study in girls failed to find a decreased global glucose metabolism, but found significant differences in glucose metabolism in 6 specific regions of the brains of ADHD girls as compared to control subjects.^The aim of this article is to illustrate current treatment modalities(s), compare them to neurofeedback, and present the benefits of utilizing this method of treatment to control and potentially alleviate the symptoms of ADHD. In addition, this article examines the prevalence rates and possible etiology of ADHD, the factors associated with ADHD and brain dysfunction, the current pharmacological treatments of ADHD, Ritalin, and the potential risks and side effects.

^More observational studies are required (particularly case-control or cohort studies) to gain a better understanding of adverse effects associated with different treatments for ADHD. Knowledge of adverse effects may also improve through more creative use of existing drug databases.

^Atomoxetine shows no abuse potential and is not a controlled substance in the US. In November of 2002 the FDA approved atomoxetine for use in the US for the treatment of ADHD in children, adolescents and adults.

.The study also found that differences in one specific region of the frontal lobe were statistically correlated with symptom severity.^Five of these studies did not report statistical significance of the differences between the groups.

^Abdominal pain ( Evidence Table H1e ): Nineteen studies provided data on abdominal pain, but 8 did not provide data on the statistical significance of the differences among the study groups at the p=0.05 level.

[99].A further study in 1997 also failed to find global differences in glucose metabolism, but similarly found differences in glucose normalization in specific regions of the brain.^Similarly, despite the overall heterogeneity of the studies comparing different stimulants, they showed few, if any, differences among MPH, DEX, and pemoline.

.The 1997 study also noted that their findings were somewhat different than those in the 1993 study, and concluded that sexual maturation may have played a role in this discrepancy.^The studies available indicate consistently that stimulants (particularly MPH) may be more effective than nonpharmacological interventions when compared head to head.

[100].The significance of the research by Zametkin has not been determined and neither his group nor any other has been able to replicate the 1990 results.^The study did not include girls or boys in other ethnic groups, so it is not known if these results are generally applicable.

.Critics, such as Jonathan Leo and David Cohen, who reject the characterization of ADHD as a disorder, contend that the controls for stimulant medication usage were inadequate in some lobar volumetric studies which makes it impossible to determine whether ADHD itself or psychotropic medication used to treat ADHD is responsible for the decreased thickness observed[104] in certain brain regions.^Decreases in observing response latency and correct choice response latency occurred after taking stimulant medication.

^Borden and Brown, 1989 (cognitive behavior therapy vs. This study was designed to determine whether those treated with combination of medication and CBT would tend to make external attributions for problem solutions or whether more internal attributions would be observed with CBT alone.

.While the main study in question used age-matched controls, it did not provide information on height and weight of the subjects.^Abdominal pain ( Evidence Table H1e ): Nineteen studies provided data on abdominal pain, but 8 did not provide data on the statistical significance of the differences among the study groups at the p=0.05 level.

.These variables it has been argued could account for the regional brain size differences rather than ADHD itself.^These differences in brain activity and structure are mainly evident in the prefrontal cortex, the basal ganglia, and the cerebellum (Castellanos & Swanson, in press).

[105][106].They believe many neuroimaging studies are oversimplified in both popular and scientific discourse and given undue weight despite deficiencies in experimental methodology.^Many experts believe that the disorder is both over- and underdiagnosed.

Diagnosis

.ADHD is diagnosed via a psychiatric assessment; to rule out other potential causes or comorbidities, physical examination, radiological imaging, and laboratory tests may be used.^Based on the history and physical examination, further work-up may be indicated in areas such as genetic or chromosomal, neurological, or biomedical conditions.

^Patients undergoing further assessment for biomedical, emotional/psychiatric, family/psychosocial, speech/language, and academic/learning problems may be identified as having a related comorbidity to the primary ADHD condition.

.In North America, the DSM-IV criteria are often the basis for a diagnosis, while European countries usually use the ICD-10.^The word often appears before each symptom of inattention, hyperactivity, and impulsivity in the DSM-IV-TR. In order to be considered a symptom of AD/HD, a behavior can't be "a once in a while" problem.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^ADHD in Children With Heart Disease ADHD may be more prevalent in children with heart disease than in the general pediatric population.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

[13].Factors other than those within the DSM or ICD however have been found to effect the diagnosis in clinical practice.^Hallucinations occurred more often in medicated children than has been reported in other studies (3/61), but on the whole, adverse effects were few and relatively mild.

.A child's social and school environment as well as academic pressures at school are likely to be of influence.^The information provided by the parents, classroom teacher and school counselor about the child's academic difficulties guides the pediatrician to form an initial diagnosis.

.Many of the symptoms of ADHD occur from time to time in everyone; in patients with ADHD, the frequency of these symptoms is greater and patients' lives are significantly impaired.^Insomnia was the only adverse event to occur with significantly greater frequency in a modafinil group (200/100) than in the placebo group (14% vs. CONCLUSION: Modafinil significantly improved ADHD symptoms in children.

^This preliminary study compared the daily living skills of children with and without attention-deficit-hyperactivity disorder (ADHD), and the influence of a social skills training group on these skills.

.Impairment must occur in multiple settings to be classified as ADHD.[34] As with many other psychiatric and medical disorders, the formal diagnosis is made by a qualified professional in the field based on a set number of criteria.^Further complicating diagnosis is that ADHD is associated with multiple functional impairments and comorbid psychiatric disorders.

^METHODS: Review by 50 psychiatrists and 50 primary care practitioners (PCPs) of 537 and 317 medical records, respectively, of adults diagnosed as having ADHD. Information on other psychiatric disorders, time of onset of ADHD, source of referral, use of referrals for diagnosis, ADHD treatment, and use of drug holidays was recorded.

.In the USA these criteria are laid down by the American Psychiatric Association in their Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th edition.^The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) distinguishes among a primarily inattentive subtype, a hyperactive-impulsive subtype, and a combined subtype ( American Psychiatric Association, 1994 ).

ADHD, Predominantly Hyperactive-Impulsive Type: if criterion 1B is met but criterion 1A is not met for the past six months.

.The previously used term ADD expired with the most recent revision of the DSM. Consequently, ADHD is the current nomenclature used to describe the disorder as one distinct disorder which can manifest itself as being a primary deficit resulting in hyperactivity/impulsivity (ADHD, predominately hyperactive-impulsive type) or inattention (ADHD predominately inattentive type) or both (ADHD combined type).^Atomoxetine for attention deficit/hyperactivity disorder.

.III. Some impairment from the signs is present in two or more settings (such as at school/work and at home).^C Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home).

^There must be clear evidence of significant difficulty in two or more settings (e.g., at home, in school, with peers, or at work) Symptoms of inattention, hyperactivity, or impulsivity must be present at least six months Some of these symptoms have to cause problems before age 7 The symptoms have to be developmentally inappropriate "Developmentally inappropriate" is an important point.

.IV. There must be clear evidence of significant impairment in social, school, or work functioning.^D. There must be clear evidence of clinically significant impairment in social, academic or occupational functioning.

The Child With ADHD: Using the AAP Clinical Practice Guideline - May 1, 2001 - American Family Physician19 January 2010 8:47 UTCwww.aafp.org [Source type: Academic]

^There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

.V. The signs do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder.^E The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

^Generally, the DSM-IV-TR requires clinicians to rule out AD/HD if they see Pervasive Developmental Disorder (PDD), schizophrenia, other psychotic disorders, or if the symptoms are better explained by another disorder.

^Objective: This pilot study examined the effects of atomoxetine on attention-deficit/hyperactivity disorder (ADHD) symptoms and autistic features in children with pervasive developmental disorders (PDD).

.The signs are not better accounted for by another mental disorder (such as Mood Disorder, Anxiety Disorder, Dissociative Identity Disorder, or a Personality Disorder).^E The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

The importance of obtaining information about the child’s signs in more than one setting.

The search for coexisting conditions that may make the diagnosis more difficult or complicate treatment planning.

.All three criteria are determined using the patient's history given by the parents, teachers and/or the patient.^Inclusion and Exclusion Criteria (questions 21, 22): Inclusion and exclusion criteria are used to determine patient eligibility for study enlistment.

.Adults often continue to be impaired by ADHD. Adults with ADHD are diagnosed under the same criteria, including the stipulation that their signs must have been present prior to the age of seven.^The children included in this study had diagnoses of ADHD with depressive symptoms, ADHD and major depressive disorder, or major depressive disorder with prominent attentional symptoms.

[110].Adults face some of their greatest challenges in the areas of self-control and self-motivation, as well as executive functioning, usually having more signs of inattention and fewer of hyperactivity or impulsiveness than children do.^Six or more of the symptoms of hyperactivity-impulsivity, but fewer than six of the symptoms of inattention have persisted for at least six months in a child's behavior.

.About 20% to 25% of children with ODD meet criteria for a learning disorder.^PubMed ] O'Toole K, Abramowitz A, Morris R, Dulcan M. Effects of methylphenidate on attention and nonverbal learning in children with attention-deficit hyperactivity disorder.

[114].Learning disorders are more common when there are inattention signs.^CONCLUSIONS. There is a clear correlation between ADHD and sleep disorders and they are very common in visits to the neuropaediatric department.

^Overview of ADHD in the General Population of Children ADHD, the most common neurobehavioral disorder of childhood, is characterized by developmentally inappropriate levels of hyperactivity, inattention, and impulsivity.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

.Psychosocial therapy is useful in treating some comorbid conditions.^Clinical guidelines for each of these agents, as well as their use in combination with stimulants in comorbid conditions, will be discussed.

^Combination Therapy of Clonidine and Stimulants or Antidepressants Combining clonidine and stimulants is a common clinical practice frequently used to treat ADHD with comorbid oppositional defiant, conduct disorder, tics, and insomnia.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

[116] ADHD is not, in boys, associated with increased substance misuse unless there is comorbid conduct disorder; but "research needs to examine the extent to which ADHD in adulthood increases the risk of substance use disorders."[117]

.Depression may also coincide with ADHD, increasingly prevalent among girls and older children.^The children included in this study had diagnoses of ADHD with depressive symptoms, ADHD and major depressive disorder, or major depressive disorder with prominent attentional symptoms.

^ADHD in Children With Heart Disease ADHD may be more prevalent in children with heart disease than in the general pediatric population.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^According to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), the prevalence of ADHD in school-age children is 3 to 5 percent.

.Epilepsy is a commonly found comorbid disorder in ADHD diagnosed individuals.^The children included in this study had diagnoses of ADHD with depressive symptoms, ADHD and major depressive disorder, or major depressive disorder with prominent attentional symptoms.

Some forms of epilepsy can also cause ADHD like behaviour which can be misdiagnosed as ADHD.[118][119]

Differential diagnoses

.To make the diagnosis of ADHD, a number of other possible medical and psychological conditions must be excluded.^Studies including conditions other than ADHD were reported if separate subgroup analyses for patients with ADHD were provided.

^Other Pharmacological Treatment of ADHD A medication shown to be effective for which FDA approval for ADHD is being sought is guanfacine (Tenex).

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^General Side Effects of Stimulant Drugs The common side effects of stimulant medications include decreased appetite, insomnia, emotional lability, stomachaches, and headaches.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

.As with other psychological and neurological issues, the relationship between ADHD and sleep is complex.^CONCLUSIONS. There is a clear correlation between ADHD and sleep disorders and they are very common in visits to the neuropaediatric department.

.In addition to clinical observations, there is substantial empirical evidence from a neuroanatomic standpoint to suggest that there is considerable overlap in the central nervous system centers that regulate sleep and those that regulate attention/arousal.^Central Nervous System Involvement Converging evidence from neuropsychology, neuroimaging, neuropharmacology, and genetics suggests involvement of the frontostriatal dopaminergic circuits in the brain.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^Conclusion: The trial suggests scientific evidence of the effectiveness of homeopathy in the treatment of attention deficit hyperactivity disorder, particularly in the areas of behavioural and cognitive functions.

[121].Primary sleep disorders play a role in the clinical presentation of symptoms of inattention and behavioral dysregulation.^RESULTS: In each study, atomoxetine was statistically superior to placebo in reducing both inattentive and hyperactive and impulsive symptoms as assessed by primary and secondary measures.

^The word often appears before each symptom of inattention, hyperactivity, and impulsivity in the DSM-IV-TR. In order to be considered a symptom of AD/HD, a behavior can't be "a once in a while" problem.

There are multilevel and bidirectional relationships among sleep, neurobehavioral functioning and the clinical syndrome of ADHD.[122]

.Behavioral manifestations of sleepiness in children range from the classic ones (yawning, rubbing eyes), to externalizing behaviors (impulsivity, hyperactivity, aggressiveness), to mood lability and inattentiveness.^With AD/HD, these are manifested to the world as inattention, hyperactivity, impulsivity, and related behaviors.

[121][123][124].Many sleep disorders are important causes of symptoms which may overlap with the cardinal symptoms of ADHD; children with ADHD should be regularly and systematically assessed for sleep problems.^OBJECTIVE: To test the hypothesis that transdermal nicotine would be efficacious for the treatment of children and adolescents with attention deficit hyperactivity disorder (ADHD).

^Ballon JS, Feifel D. Department of Psychiatry, University of California, San Diego, CA, USA. BACKGROUND: Modafinil is a novel wake-promoting agent that has U.S. Food and Drug Administration approval for narcolepsy and shift work sleep disorder and as adjunctive treatment of obstructive sleep apnea/hypopnea syndrome.

^Most studies did not clearly describe clinically important information such as the primary outcomes of interest, the presence of comorbid disorders, the characteristics of the patients' families, compliance with treatment, and baseline measurement of outcomes of interest.

.A study in the Netherlands compared two groups of unmedicated 6-12-year-olds, all of them with "rigorously diagnosed ADHD". 87 of them had problems getting to sleep, 33 had no sleep problems.^The children included in this study had diagnoses of ADHD with depressive symptoms, ADHD and major depressive disorder, or major depressive disorder with prominent attentional symptoms.

^This preliminary study compared the daily living skills of children with and without attention-deficit-hyperactivity disorder (ADHD), and the influence of a social skills training group on these skills.

.The larger group had a significantly later dim light melatonin onset (DLMO) than did the children with no sleep problems.^CONCLUSION:: Combined sleep hygiene and melatonin was a safe and effective treatment for initial insomnia in children with ADHD taking stimulant medication.

Management

.Methods of treatment often involve some combination of behavior modification, life-style changes, counseling, and medication.^Change evaluation methods to suit the child's learning styles and strengths.

.A 2005 study found that medical management and behavioral treatment is the most effective ADHD management strategy, followed by medication alone, and then behavioral treatment.^Overall, the most frequent treatment was stimulant medication alone (42.0%).

[127].While medication has been shown to improve behavior when taken over the short term, they have not been shown to alter long term outcomes.^Few long-term followup studies of the effectiveness of treatment for ADHD have been conducted even in the area of medication trials.

^In conclusion, memory capacities seem normal in AD/HD. Methylphenidate does not have an effect on the memory capacities, but may improve the strategies in which the short-term memory can be effectively transferred to the long-term memory.

.Parent training and education have been found to have short term benefits.^The MTA confirmed the findings of previous studies demonstrating short-term benefits do continue during longer term treatment ( MTA Cooperative Group, 1999 ).

[130].Family therapy has shown to be of little use in the treatment of ADHD,[131] though it may be worth noting that parents of children with ADHD are more likely to divorce than parents of children without ADHD, particularly when their children are younger than eight years old.^Treatment Setting (more than one (more...

^Krause, Dresel, Krause, la Fougere, and Ackenheil (2003) report that individuals with ADHD are far more likely to smoke than are individuals with ADD: “It was striking how many of the 20- to 40-year-old patients in our group, who had shown symptoms of hyperactivity and impulsivity in childhood, were smokers: nine smoked and only three were non-smokers … The opposite was shown in the patients with only inattentive symptoms throughout their whole life: only two smoked, seven were non-smokers” (pp.

.The researcher advises that when they are doing homework, one should let them fidget, stand or chew gum since it may help them cope.^A buddy system to check the completion of each agenda and the inclusion in backpacks of materials required to complete homework can help to ensure students take home what they need.

Medications

.Management with medication has been shown to be the most cost-effective, followed by behavioral treatment and combined treatment in a 14 month follow-up study.^This study examined long-term (14 months with a 24-month followup) effectiveness of medication for treatment of ADHD vs. In a parallel-groups design, 576 children (age 7 to 9 years) with ADHD were thoroughly assessed and randomized to 4 conditions: (1) medication alone, (2) psychosocial treatment alone, (3) the combination of both, or (4) community comparison ( Richters, Arnold, Jensen et al., 1995 ).

[127].However, a longer follow-up study of 3 years found that stimulant medication offered no benefits over behavioral therapy in children.^However, the studies lack information on the reasons that so many children discontinue medication and provide little evidence for improvement in academic performance with stimulants, even though MPH treatment does appear to produce consistent behavior improvement.

^Although both stimulant medication and behavioral therapy have been shown to improve symptoms in children with ADHD, 148 the National Institute of Mental Health–funded multisite trial comparing pharmacological and an intensive behavioral treatment for ADHD found that parent and teacher ratings of ADHD symptoms improved significantly more for children on stimulant medication than with an intensive behavioral treatment (MTA Cooperative Group, 1999).

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^However, while no firm conclusions can be drawn, there are indications that the instructional approach may have contributed to a reduction of impulsive and restless behaviors in the classroom.

[133].Stimulant medication or non-stimulant medication may be prescribed.^It has been hypothesized that individuals with ADHD who are not taking stimulant medication may try to self-medicate by smoking.

.A 2007 drug class review found that there are no good studies of comparative effectiveness between various drugs for ADHD and that there is a lack of quality evidence on their effects on overall academic performance and social behaviors.^There was evidence of relapse between 3 and 6 months.

^However, the studies lack information on the reasons that so many children discontinue medication and provide little evidence for improvement in academic performance with stimulants, even though MPH treatment does appear to produce consistent behavior improvement.

[134].ADHD medications are not recommended for preschool children as their long term effects in such young people are unknown.^Few long-term followup studies of the effectiveness of treatment for ADHD have been conducted even in the area of medication trials.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

.Stimulants used to treat ADHD raise the extracellular concentrations of the neurotransmittersdopamine and norepinephrine which causes an increase in neurotransmission.^Food and Drug Administration-approved medications for ADHD include the stimulants and nonstimulants, although tricyclic antidepressants and bupropion are also commonly used.

.A meta analysis of clinical trials found that about 70% of children improve after being treated with stimulants in the short term but found that this conclusion may be biased due to the high number of low quality clinical trials in the literature.^Selegiline in comparison with methylphenidate in attention deficit hyperactivity disorder children and adolescents in a double-blind, randomized clinical trial.

.Thus the long term effectiveness of methylphenidate has not been scientifically demonstrated.^Few long-term followup studies of the effectiveness of treatment for ADHD have been conducted even in the area of medication trials.

^In conclusion, memory capacities seem normal in AD/HD. Methylphenidate does not have an effect on the memory capacities, but may improve the strategies in which the short-term memory can be effectively transferred to the long-term memory.

.Serious concerns of publication bias regarding the use of methylphenidate for ADHD has also been noted.^CONCLUSION: In adolescents, once-daily OROS methylphenidate significantly reduced ADHD symptoms and was well tolerated using dosages up to 72 mg/d.

.Higher rates of schizophrenia and bipolar disorder as well as increased severity of these disorders occur in individuals with a past history of stimulant use for ADHD in childhood.^Various diagnostic models may well define samples that differ in natural history, severity, comorbidity, ADHD subtype, and response to treatment.

^This preliminary study compared the daily living skills of children with and without attention-deficit-hyperactivity disorder (ADHD), and the influence of a social skills training group on these skills.

.Both children with and without ADHD abuse stimulants, with ADHD individuals being at the highest risk of abusing or diverting their stimulant prescriptions.^Atomoxetine shows no abuse potential and is not a controlled substance in the US. In November of 2002 the FDA approved atomoxetine for use in the US for the treatment of ADHD in children, adolescents and adults.

.Between 16 and 29 percent of students who are prescribed stimulants report diverting their prescriptions.^Stimulant medications are often prescribed in the treatment of AD/HD. Many people question why stimulants would be used for students who already appear to be over stimulated.

Most often their motivation is to concentrate, improve alertness, "get high," or to experiment.[144]

.One study found that children with ADHD actually need to move more to maintain the required level of alertness while performing tasks that challenge their working memory.^What limits children's working memory span?

.Performing math problems mentally and remembering multi-step directions are examples of tasks that require working memory, which involves remembering and manipulating information for a short time.^Working memory (WM) capacity is the ability to retain and manipulate information during a short period of time.

.These findings may also explain why stimulant medications improve the behavior of most children with ADHD. Those medications improve the physiological arousal of children with ADHD, increasing their alertness.^MPH may reduce behavioral disturbance in children with ADHD while it is taken.

^We would agree with the conclusion of a recent special article in Pediatrics that states that "there does not seem to be compelling findings of a medication-specific risk necessitating changes in our stimulant treatment of children and adolescents with ADHD." 150 Although those authors suggest that the "use of existing guidelines on the use of stimulants (and psychotropic agents) may identify children, adolescents and adults who are vulnerable to sudden death," we offer the following recommendations as a refinement of these previous guidelines to aid in the identification of children who are potentially at an increased risk from any type of increased stimulation.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^CONCLUSIONS: Poor parental supervision might serve as a mechanism to explain why children with behavior disorders, and those with oppositional behavior patterns in particular, have increased risk of unintentional injury.

.Although "under medical supervision, stimulant medications are considered safe",[112][145] the use of stimulant medications for the treatment of ADHD has generated controversy because of undesirable side effects, uncertain long term effects[10][136][146][147][148] and social and ethical issues regarding their use and dispensation.^Although stimulant medications are an effective first-line treatment for ADHD , concern persists regarding the possible side effects and long-term health outcomes associated with stimulant consumption.

.The FDA has added black-box warnings to some ADHD medications,[149][150] while the American Heart Association and the American Academy of Pediatrics feel that it is prudent to carefully assess children for heart conditions before treating them with stimulant medications.^Children are often treated with medication, usually stimulant medication such as methylphenidate.

^The FDA advisory panel recommended with an 8-to-7 vote that a "black box" warning about possible cardiovascular risks associated with stimulant medications used to treat ADHD be added to the drug labeling.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^The FDA stated that "the number of cases of sudden deaths reported for Adderall is only slightly greater, per million prescriptions, than the number reported for methylphenidate products, which are also commonly used to treat pediatric patients with ADHD." 39b Despite the lack of data to support limiting the use of the stimulant medications in children with heart disease, in August 2005, the FDA added a warning to the Adderall labeling, titled "Sudden Death and Preexisting Structural Cardiac Abnormalities," which states, "Sudden death has been reported in association with amphetamine treatment at usual doses in children with structural cardiac abnormalities.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^Atomoxetine shows no abuse potential and is not a controlled substance in the US. In November of 2002 the FDA approved atomoxetine for use in the US for the treatment of ADHD in children, adolescents and adults.

.Antipsychotics work by blocking dopamine whereas stimulants trigger its release, putting further stigma on the pharmacological treatment of ADHD. As a second-line approach to treatment in children who do not respond to stimulant medications, this class of drugs has not been well-studied or proven to work safely in children with the disorder.^A replication study of diagnosis and drug treatment.

^Future studies are necessary to assess the true risk of SCD in association with stimulant drugs in children and adolescents with and without heart disease.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

.There have been double-blind randomised controlled trials that have demonstrated the efficacy and tolerability of modafinil,[158][159] however there are risks of serious side effects such as skin reactions and modafinil is not recommended for use in children.^DATA SYNTHESIS: There have been 33 double-blind, placebo-controlled trials of modafinil.

Experimental and alternative treatments

.Dietary supplements and specialized diets are sometimes used by people with ADHD with the intent to mitigate some or all of the symptoms.^ADHD symptoms were assessed using parent- and investigator-rated scales.

For example, Omega-3 supplementation (seal, fish or krill oil) may reduce ADHD symptoms for a subgroup of children and adolescents with ADHD "characterized by inattention and associated neurodevelopmental disorders."[161] Although vitamin or mineral supplements (micronutrients) may help children diagnosed with particular deficiencies, there is no evidence that they are helpful for all children with ADHD. Furthermore, megadoses of vitamins, which can be toxic, must be avoided.[162] In the United States, no dietary supplement has been approved for the treatment for ADHD by the FDA.[163] There is however a pilot study done which shows that phosphatidyl serine (PS) can help against ADHD.[164]

.EEG biofeedback is a treatment strategy used for children, adolescents and adults with ADHD.[165] The human brain emits electrical energy which is measured with electrodes on the brain.^Atomoxetine treatment in children and adolescents with ADHD and comorbid tic disorders.

^It also included a description of the search strategy used to identify literature on the assessment and treatment of children, adolescents, and adults with ADHD. The report did not present the issues of interest as questions but was structured following clear sections by topics of interest.

^Atomoxetine shows no abuse potential and is not a controlled substance in the US. In November of 2002 the FDA approved atomoxetine for use in the US for the treatment of ADHD in children, adolescents and adults.

.Biofeedback alerts the patient when beta waves are present.^ECG abnormalities are present in 90% of LQTS patients and include prolongation of the corrected QT interval (QTc) with abnormal T-wave morphology.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

.This theory believes that those with ADHD can train themselves to decrease ADHD symptoms.^Adult ADHD often presents differently from childhood ADHD. Because adult ADHD can be comorbid with other disorders and has symptoms similar to those of other disorders, it is important to understand differential diagnoses.

.There is a distinct split in the scientific community about the effectiveness of the treatment.^Conclusion: The trial suggests scientific evidence of the effectiveness of homeopathy in the treatment of attention deficit hyperactivity disorder, particularly in the areas of behavioural and cognitive functions.

.A number of studies indicate the scientific evidence has been increasing in recent years for the effectiveness of EEG biofeedback for the treatment of ADHD. According to a 2007 review, with effectiveness of the treatment was demonstrated to be equivalent to that of stimulant medication.^Stimulant treatment over five years: adherence, effectiveness, and adverse effects.

^Therefore, research has been directed towards determining if the treatment of ADHD with stimulant medications can be safe and effective for the individual with active SUD and concomitant ADHD. An initial trial of methylphenidate in a population of adults with active cocaine dependence and ADHD indicates that this is the case.

.The review noted, improvements are seen at the behavioral and neuropsychological level with the symptoms of inattention, hyperactivity and impulsivity showing significant decreases after treatment.^Six or more of the symptoms of hyperactivity-impulsivity, but fewer than six of the symptoms of inattention have persisted for at least six months in a child's behavior.

.There are no known side effects from EEG biofeedback therapy.^PubMed ] Linden M, Habib T, Radojevic V. A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities.

.There are methodological limitations and weaknesses in study designs however.^However, we regarded these study designs as too vulnerable to bias and of limited value for direct head-to-head comparisons between psychosocial therapies and interventions.

.In a 2005 review, Loo and Barkley stated that problems including lack of blinding such as placebo control and randomisation are significant limitations to the studies into EEG biofeedback and make definitive conclusions impossible to make.^A pilot placebo-controlled study.

[166].As a result more robust clinical studies have been strongly recommended.^Drug vs. Despite the limitations in the individual studies, the results indicate consistently that stimulants are more effective than nonpharmacological interventions when compared head-to-head.

[167].A German review in 2004 found that EEG biofeedback, also sometimes referred to as neurofeedback, is more effective than previously thought in treating attention deficiency, impulsivity and hyperactivity; short-term effects match those of stimulant treatment and a persistent normalization of EEG parameters is found which is not found after treatment with stimulants.^Longer term effects of stimulant treatments for Attention-Deficit/Hyperactivity Disorder.

[168].There are no known side effects from biofeedback therapy although research into biofeedback has been limited and further research has been recommended.^No significant side effects or worsening of manic symptoms was observed.

^Although the overall percentage of subjects having any side effect on both methylphenidate and placebo was rather high, side effects on methylphenidate over and above those on placebo were few and mild.

[168] An American review the following year also emphasized the benefits of this method.[169] Similar findings were reported in a study by another German team in 2004.[170]

.Aerobic fitness may improve cognitive functioning and neural organization related to executive control during pre-adolescent development, though more studies are needed in this area.^Executive function is taxed when conscious, top-down control is needed.

^Faster processing and improved executive function performance may covary because they both reflect more efficient neural processing and improved signal/noise ratios, either because of systemwide improvements in the nervous system or because a better functioning prefrontal cortex improves signal/noise ratios for diverse neural regions, permitting faster and more efficient cognitive processing.

.Art is thought by some to be an effective therapy for some of the symptoms of ADHD. Other sources, including some psychologists who have written on the subject, feel that cutting down on time spent on television, video games, or violent media can help some children.^The children included in this study had diagnoses of ADHD with depressive symptoms, ADHD and major depressive disorder, or major depressive disorder with prominent attentional symptoms.

^Objective: This pilot study examined the effects of atomoxetine on attention-deficit/hyperactivity disorder (ADHD) symptoms and autistic features in children with pervasive developmental disorders (PDD).

.One study indicated a correlation between excessive TV time as a child with higher rates of ADHD symptoms.^The children included in this study had diagnoses of ADHD with depressive symptoms, ADHD and major depressive disorder, or major depressive disorder with prominent attentional symptoms.

[173].Other therapies that have been effective for some have been ADHD coaching, positive changes in diet, such as low sugar, low additives, and no caffeine.^Paroxetine had no effect on ADHD. Hamilton Rating Scales for Anxiety (HAM-A) and Depression (HAM-D) scores were low to start, and no treatment differences were evident at endpoint.

^Atomoxetine shows no abuse potential and is not a controlled substance in the US. In November of 2002 the FDA approved atomoxetine for use in the US for the treatment of ADHD in children, adolescents and adults.

[175].In the United States, 37% of those with ADHD do not get a high school diploma even though many of them will receive special education services.^Individuals with ADHD also tend to consume a disproportionate share of resources and attention from educators, the health care system, social service agencies, and the legal system.

^Estimating the number of children who have had ADHD diagnosed and are currently taking medication for the disorder is an important step toward understanding the overall burden of ADHD in the United States.

^Doggett AM. School of Education, Colorado State University, USA. doggett@lamar.colostate.edu The purpose of this article is to discuss alternative treatments other than drug therapy for Attention-Deficit/Hyperactive Disorder (ADHD) in educational settings.

[25].A 1995 briefing citing a 1994 book review says the combined outcomes of the expulsion and dropout rates indicate that almost half of all ADHD students never finish high school.^See more articles cited in this paragraph A chart review study of the inattentive and combined types of ADHD. J Atten Disord.

[176].Also in the US, less than 5% of individuals with ADHD get a college degree[177] compared to 28% of the general population.^ADHD in Children With Heart Disease ADHD may be more prevalent in children with heart disease than in the general pediatric population.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^Adult ADHD seems to be a reality, but much less frequent than in youths.

[178].Those with ADHD as children are at increased risk of a number of adverse life outcomes once they become teenagers.^Because both substantial health risks and benefits might be associated with medication treatment for ADHD, further study of this population of children with ADHD is needed.

These include a greater risk of auto crashes, injury and higher medical expenses, earlier sexual activity, and teen pregnancy.[179].Russell Barkley states that adult ADHD impairments affect "education, occupation, social relationships, sexual activities, dating and marriage, parenting and offspring psychological morbidity, crime and drug abuse, health and related lifestyles, financial management, or driving.^Atomoxetine shows no abuse potential and is not a controlled substance in the US. In November of 2002 the FDA approved atomoxetine for use in the US for the treatment of ADHD in children, adolescents and adults.

.ADHD can be found to produce diverse and serious impairments".[180] The proportion of children meeting the diagnostic criteria for ADHD drops by about 50% over three years after the diagnosis.^Children with ADHD can have academic impairments, social dysfunction, and poor self-esteem.

^This report describes the results of that analysis, which indicated that, in 2003, approximately 4.4 million children aged 4-17 years were reported to have a history of ADHD diagnosis; of these, 2.5 million (56%) were reported to be taking medication for the disorder.

.This occurs regardless of the treatments used and also occurs in untreated children with ADHD.[120][133][147] ADHD persists into adulthood in about 30-50% of cases.^A large percentage of children diagnosed with ADHD have symptoms that persist into adolescence and adulthood.

^Atomoxetine shows no abuse potential and is not a controlled substance in the US. In November of 2002 the FDA approved atomoxetine for use in the US for the treatment of ADHD in children, adolescents and adults.

[7] Those affected are likely to develop coping mechanisms as they mature, thus compensating for their previous ADHD.[9]

Epidemiology

Percent of United States youth 4-17 years of age ever diagnosed with ADHD as of 2003.[181]

.ADHD's global prevalence is estimated at 3-5% in people under the age of 19. There is, however, both geographical and local variability among studies.^Prevalence estimates of ADHD vary according to the methods of ascertainment, diagnostic criteria, informants, and population sampled.

^However, given the present debate around the existence of ADHD, the variation in estimates of prevalence, and the frequency with which comorbid disorders are identified, it is not surprising to find wide variation and controversy around its treatment.

.Geographically, children in North America appear to have a higher rate of ADHD than children in Africa and the Middle East,[182] well published studies have found rates of ADHD as low as 2% and as high as 14% among school aged children.^All but six studies were published in North America.

[27].The rates of diagnosis and treatment of ADHD are also much higher on the East Coast of the USA than on the West Coast.^RECENT FINDINGS: Recent evidence suggests that the overall rate of medication treatment for ADHD has been increasing, with over 2 million children being treated with stimulants in 1997.

[183].The frequency of the diagnosis differs between male children (10%) and female children (4%) in the United States.^HCM has a prevalence of 1 in 500 in the United States, with an incidence of sudden death in children of 2% to 8% per year.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^They administered a spatial-span task and found a striking difference between children with ADHD broadly defined and controls.

[184].This difference between genders may reflect either a difference in susceptibility or that females with ADHD are less likely to be diagnosed than males.^Various diagnostic models may well define samples that differ in natural history, severity, comorbidity, ADHD subtype, and response to treatment.

.Rates of ADHD diagnosis and treatment have increased in both the UK and the USA since the 1970s.^Because both substantial health risks and benefits might be associated with medication treatment for ADHD, further study of this population of children with ADHD is needed.

.In the UK an estimated 0.5 per 1,000 children had ADHD in the 1970s, while 3 per 1,000 received ADHD medications in the late 1990s.^Because both substantial health risks and benefits might be associated with medication treatment for ADHD, further study of this population of children with ADHD is needed.

.In the USA in the 1970s 12 per 1,000 children had the diagnosis, while in the late 1990s 34 per 1,000 had the diagnosis and the numbers continue to increase.^The diagnosis and treatment of attention-deficit hyperactivity disorder continues to raise controversy, and, there is also an increase in treatment options.

.Adults are likely not to be diagnosed or treated for ADHD. This may result in a substantial underestimation of prevalence in most populations.^Most adult sufferers of ADHD have not been properly diagnosed or treated.

.Awareness about Hyperactivity and ADHD or its signs and symptoms has been rudimentary until early 1990 across Europe.^Objective: This pilot study examined the effects of atomoxetine on attention-deficit/hyperactivity disorder (ADHD) symptoms and autistic features in children with pervasive developmental disorders (PDD).

.In the UK in 2003 a prevalence of 3.6% is reported in male children and less than 1% is reported in female children.^ADHD in Children With Heart Disease ADHD may be more prevalent in children with heart disease than in the general pediatric population.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^Consistently, the disorder is diagnosed more frequently in males than in females ( American Academy of Child and Adolescent Psychiatry, 1997a ; American Psychiatric Association, 1994 ).

.As of 2009, eight percent of all Major League Baseball players have been diagnosed with ADHD, making the disease epidemic among this population.^The children included in this study had diagnoses of ADHD with depressive symptoms, ADHD and major depressive disorder, or major depressive disorder with prominent attentional symptoms.

^ADHD in Children With Heart Disease ADHD may be more prevalent in children with heart disease than in the general pediatric population.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

^The points I make in this paper include the following: many individuals currently diagnosed with the inattentive subtype of ADHD appear to be misdiagnosed.

History

Hyperactivity has long been part of the human condition. .Sir Alexander Crichton describes "mental restlessness" in his book An Inquiry Into the Nature and Origin of Mental Derangement written in 1798.[188][189] The terminology used to describe the symptoms of ADHD has gone through many changes over history including: "minimal brain damage", "minimal brain dysfunction" (or disorder),[190] "learning/behavioral disabilities" and "hyperactivity". In the DSM-II (1968) it was the "Hyperkinetic Reaction of Childhood". In the DSM-III "ADD (Attention-Deficit Disorder) with or without hyperactivity" was introduced.^Advocating for students with learning disabilities and attention deficit hyperactivity disorder in public schools.

[191] The use of stimulants to treat ADHD was first described in 1937.[192]

Society and culture

The media have reported on many issues related to ADHD. In 2001 PBS's Frontline aired a one-hour program about the effects of the diagnosis and treatment of ADHD in minors, entitled "Medicating Kids."[193] The program included a selection of interviews with representatives of various points of view. .In one segment, entitled Backlash, retired neurologistFred Baughman and Peter Breggin whom PBS described as "outspoken critics who insist [ADHD is] a fraud perpetrated by the psychiatric and pharmaceutical industries on families anxious to understand their children's behavior"[194] were interviewed on the legitimacy of the disorder.^The children had been referred to a psychiatric clinic for disruptive behavior problems and met criteria for ADHD based on parent and teacher interviews.

.Russell Barkley and Xavier Castellanos, then head of ADHD research at the National Institute of Mental Health (NIMH), defended the viability of the disorder.^The NIH has also funded a long-term, collaborative Multimodal Treatment Study of Children with ADHD (the MTA Collaborative Group study) to address issues emphasized by the Institute of Medicine study Research on Children and Adolescents with Mental, Behavioral, and Developmental Disorders , the National Institute of Mental Health (NIMH) National Plan for Research on Child and Adolescent Mental Disorders , the Healthy People 2000 , and Healthy Children 2000 .

In the interview with Castellanos, he stated that little is scientifically understood.[195] Lawrence Diller was interviewed on the business of ADHD along with a representative from Shire Plc.[citation needed]

A number of notable individuals have given controversial opinions on ADHD. ScientologistTom Cruise's interview with Matt Lauer was widely watched by the public. .In this interview he spoke about postpartum depression and also referred to Ritalin and Adderall as being "street drugs" rather than as ADHD medication.^Food and Drug Administration-approved medications for ADHD include the stimulants and nonstimulants, although tricyclic antidepressants and bupropion are also commonly used.

[196].In England BaronessSusan Greenfield, a leading neuroscientist, spoke out publicly about the need for a wide-ranging inquiry in the House of Lords into the dramatic increase in the diagnosis of ADHD in the UK and possible causes[197] following a 2007 BBC Panorama programme which highlighted US research (The Multimodal Treatment Study of Children with ADHD by the University of Buffalo showing treatment results of 600) suggesting drugs are no better than other forms of therapy for ADHD in the long term.^The results emphasize the need for a focus upon occupation in assessment and treatment of children with ADHD. ----- CNS Drugs.

[16][18][199].The controversies have involved clinicians, teachers, policymakers, parents and the media.^ADHD has been surrounded by great controversy involving clinicians, teachers, policymakers, parents, and the media.

.Opinions regarding ADHD range from not believing it exists at all to believing there are genetic and physiological bases for the condition as well as disagreement about the use of stimulant medications in treatment.^The range of opinion regarding the validity of ADHD extends from those who do not believe it exists and regard it as a myth, to those who believe that there is genetic and physiological evidence supporting its existence.

.Others have included that it may stem from a misunderstanding of the diagnostic criteria and how they are utilized by clinicians,[15]:p.3 teachers, policymakers, parents and the media.^ADHD has been surrounded by great controversy involving clinicians, teachers, policymakers, parents, and the media.

^Non-RCT studies were included if they met all of the other inclusion criteria and if they evaluated adverse effects associated with treatment for more than 12 weeks and included more than 10 patients.

^This may include other teachers, including those who have previously worked with the student, the Consulting Teacher (or special education supervisor if needed), and/or the Resource Teacher, the School Counselor, and/or the Principal or other administrator.

[17].Debates center around: whether ADHD is a disability or whether it is merely a neurological description, the cause of the disorder, the changing of the diagnostic criteria, and the rapid increase in diagnosis of ADHD and the use of stimulants to treat the disorder.^Attention-Deficit Hyperactivity Disorder (AD/HD) is a neurological disorder requiring a clinical diagnosis based on criteria outlined in The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV).

[200] Some do not believe it exists at all.[17].Long term possible side effects of stimulants and their usefulness are largely unknown because of a lack of long term studies.^The MTA study confirms that large-scale, long-term collaboration among researchers is possible.

[201] Some research raises questions about the long term effectiveness and side effects of medications used to treat ADHD.[202]

.In 1998, the US National Institutes of Health (NIH) released a consensus statement on the diagnosis and treatment of ADHD. The statement, while recognizing that stimulant treatment is controversial, supports the validity of the ADHD diagnosis and the efficacy of stimulant treatment.^The National Institutes of Health (NIH) held a consensus planning conference on ADHD in November 1998.

^Thus, in 1998, the National Institutes of Health consensus panel on the diagnosis and treatment of ADHD concluded that the costs associated with ADHD were large, stating that individuals with ADHD "consume a disproportionate share of resources and attention from the health care system, criminal justice system, schools, and other social service agencies."

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing -- Vetter et al. 117 (18): 2407 -- Circulation11 October 2009 9:35 UTCcirc.ahajournals.org [Source type: Academic]

.It found controversy only in the lack of sufficient data on long-term use of medications, and in the need for more research in many areas.^Few long-term followup studies of the effectiveness of treatment for ADHD have been conducted even in the area of medication trials.

The British Psychological Society said in a 1997 report that physicians and psychiatrists should not follow the American example of applying medical labels to such a wide variety of attention-related disorders: "The idea that children who don’t attend or who don’t sit still in school have a mental disorder is not entertained by most British clinicians."[204][205] However, several years later, in 2009, the British Psychological Society, in collaboration with the Royal College of Psychiatrists, released a set of guidelines for the diagnosis and treatment of ADHD.[206]

^Pliszka S; AACAP Work Group on Quality Issues (July 2007). "Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder". Journal of the American Academy of Child and Adolescent Psychiatry46 (7): 894–921. doi:10.1097/chi.0b013e318054e724. PMID17581453.

^Reason R; Working Party of the British Psychological Society (1999). "ADHD: a psychological response to an evolving concept. (Report of a Working Party of the British Psychological Society)". Journal of Learning Disabilities32 (1): 85–91. doi:10.1177/002221949903200108. PMID15499890.

Bibliography

Dr Jennifer Erkulwater; Dr Rick Mayes; Dr Catherine Bagwell (2009). .Medicating Children: ADHD and Pediatric Mental Health.^Because both substantial health risks and benefits might be associated with medication treatment for ADHD, further study of this population of children with ADHD is needed.

Further reading

Crawford, Teresa I'm Not Stupid!^OBJECTIVE: To test the hypothesis that transdermal nicotine would be efficacious for the treatment of children and adolescents with attention deficit hyperactivity disorder (ADHD).

^This preliminary study compared the daily living skills of children with and without attention-deficit-hyperactivity disorder (ADHD), and the influence of a social skills training group on these skills.

^Additional research should focus on the control of unspecific effects, medication, and subtypes to confirm the assumption that slow cortical potential feedback is a viable treatment option for attention-deficit/hyperactivity disorder.

Kelly, Kate, Peggy Ramundo. (1993) You Mean I'm Not Lazy, Stupid or Crazy?! .A Self-Help Book for Adults with Attention deficit Disorder.^Selegiline in comparison with methylphenidate in attention deficit hyperactivity disorder children and adolescents in a double-blind, randomized clinical trial.

Ratey, Nancy. .(2008) The Disorganized Mind: Coaching Your ADHD Brain to Take Control of Your Time, Tasks, and Talents.^Atomoxetine is a valuable new treatment option for adults with ADHD and is particularly useful in patients who are at risk for substance abuse or who do not wish to take a controlled substance.

The English used in this article or section may not be easy for everybody to understand.You can help Wikipedia by making this page or section simpler.

Attention-deficit hyperactivity disorder (ADHD) is a kind of brain disorder. It affects how people think and behave. People with ADHD usually have problems with focus and priority. An easy (though not completely correct) way to imagine what ADHD is like is to think of a shiny light or a constant noise in a room. Imagine that you want to be able to turn your attention away to focus on other things, like getting the mess cleaned up, or doing your homework, but that shiny light or that buzzing sound is constantly distracting you. This is similar to why people with ADHD have trouble focusing. They want to focus, but they are constantly being distracted by that shiny thought in their head. On the contrary, when that shiny thought is not barred from being their top priority, a person with ADHD will sometimes hyperfocus, nearly completely shutting out the rest of the world and focusing intensely.

They may also be hyperactive. Because ADHD affects how people's nerves develop, it is called a neurological developmental disorder.[1][2][3] Researchers believe that about 3-5% of the people around the world are affected by ADHD. It is also believed that the disorder is often genetically inherited.

A review of 102 studies estimated that throughout the entire world, the prevalence of ADHD in people under the age of 19 is 5.29%. Not all of the 102 studies had similar findings, though, and they used different groups of people, conditions, and measurement tools. There are more people diagnosed with ADHD in North America than there are in Africa and the Middle East.[4] In the United States, about 7% of children between 3 and 17 years old are diagnosed with ADHD. About 10% of all boys in the United States are diagnosed with ADHD, but only 4% of girls are said to have ADHD.[5] This could be because boys are more likely to get ADHD, or because girls who have ADHD are less likely to be diagnosed.[6][7]

ADHD is most often diagnosed in children, but it is common for adults to be diagnosed as well. About 60% of children diagnosed with ADHD still have the condition when they become adults.[8] Treatment is usually with a combination of medications, behavior training, lifestyle changes, and counseling. Many people who continue to have ADHD as adults learn how to make up for their difficulties.

article - Methylphenidate and Clonidine Help Children With ADHD and Tics: National Institute of Neurological Disorders and Stroke (NINDS)

Free Full Text - Arch Gen Psychiatry -- Moderators and Mediators of Treatment Response for Children With Attention-Deficit/ Hyperactivity Disorder: The Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder, December 1999, The MTA Cooperative Group 56 (12): 1088